The feasibility,acceptability and possible benefit of a positive psychology intervention group in an adolescent inpatient eating disorder service

Positive affect focused therapies could increase subjective happiness and life satisfaction for patients with eating disorders (EDs), illnesses known to significantly impact quality of life. This longitudinal pilot study aimed to develop and implement a five session ‘Positivity Group’ using positive psychology interventions (PPIs) in an adolescent ED inpatient service. Eight female inpatients aged 11–18 years attended the group and subjective happiness and life satisfaction were assessed before, after and at 6-month follow-up. Patients provided feedback on acceptability and feasibility was assessed via patient engagement, facilitator and team feedback and the data support the feasibility and acceptability of the group. A possible benefit was derived from the group, with 75% of patients reporting meaningful improvement in subjective happiness and 87.5% in life satisfaction. Involving the wider team and supporting homework were identified as considerations for future replication alongside the assessment of implementation, acceptability, feasibility and effectiveness in other clinical contexts.     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

The Use of the Devereux Scales of Mental Disorders in the Assessment of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder

The present study was designed to gather validity data on the Devereux Scales of Mental Disorders (DSMD) for distinguishing among children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 32), Conduct Disorder (CD; N = 34), or no clinical diagnosis (NC; N = 65). Three types of indicators were compared: (a) DSMD scale, composite, and total scores, (b) the number of ADHD or CD-related items endorsed, and (c) diagnostic efficiency statistics (e.g., sensitivity, positive and negative predictive power). The clinical groups did not differ significantly from each other, but both were significantly higher than the NC group on all DSMD scales. Moreover, there were significant differences between the ADHD and the CD groups on the number of respective ADHD and CD-related items endorsed. A cut-off of seven to eight items yielded the best discrimination between the two diagnostic groups. Diagnostic efficiency statistics indicate that the DSMD may be effective at differentiating between similar disruptive behavior disorders.     

The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability,Negative Beliefs,and Therapist Distress About Exposure-Based Interventions

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.     

Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia

The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.     

Social Anxiety Disorder and Perceived Criticism in Intimate Relationships: Comparisons With Normal and Clinical Control Groups

Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in socially anxious individuals’ relationships. In the present study, we compared levels of perceived, expressed, and observed criticism and reactions to criticism among individuals with SAD and their partners (n = 21), individuals with other anxiety disorders and their partners (n = 35), and couples free of psychopathology (n = 30). Participants rated both global criticism and criticism during a 10-minute problem-solving task, which was also coded for criticism by observers. Individuals with anxiety disorders showed elevated levels of interaction-specific perceived criticism, expressed criticism, and upset and stress due to criticism relative to normal controls; they also reported that the interaction was more stressful. However, there were no group differences on global measures of criticism, and the two anxious groups did not differ on any measures. Findings suggest that the high levels of criticism anxious individuals perceive and their corresponding negative reactions to criticism, though not specific to SAD, may account for some of the relationship difficulties that have been identified in SAD. Results also indicate that anxious individuals may contribute to their relationship difficulties by being highly critical themselves. Overall, our findings point to the need for a clinical focus on decreasing perceived criticism among individuals with anxiety disorders.     

Resurgence is greater following a return to the training context than remaining in the extinction context

The present study examined whether resurgence of a previously reinforced target response upon removing alternative reinforcement would be greater when (1) returning to the original training context (ABA context changes) versus (2) remaining in the analogue treatment context in which the alternative response was differentially reinforced (ABB context changes). Experiment 1 arranged reinforcement of button pressing with points exchangeable for money in university students. Experiment 2 arranged reinforcement of lever pressing with food for rats. Experiment 3 arranged reinforcement of responses to a touchscreen with small bites of food with children diagnosed with ASD. Overall, resurgence of target responding tended to be greater when returning to the original training context (A) than when remaining in the analogue treatment context (B). These findings suggest context changes with differential reinforcement treatments could exacerbate the recurrence of problem behavior resulting from reductions in treatment integrity through failure to reinforce appropriate behavior.     

Does the Good Behavior Game evoke negative peer pressure? Analyses in primary and secondary classrooms

The Good Behavior Game (GBG) is a classroom management system that employs an interdependent group contingency, whereby students work as a team to win the game. Although previous anecdotal data have suggested that this arrangement may promote prosocial behavior, teachers may have concerns about its fairness and potential to evoke negative peer interactions (especially toward students who break the rules). We evaluated disruptive behaviors and social interactions during the GBG in a secondary classroom for students with emotional and behavioral disorders, as well as in a primary classroom for students with mild developmental disabilities. Results indicate that the GBG reduced disruptive behaviors; further, negative peer interactions decreased and positive interactions increased when the game was being played. Social validity results indicate that the majority of students thought the interdependent group contingency was fair.     

Postural control after unexpected external perturbation: Effects of Parkinson’s disease subtype

Different clinical subtypes of Parkinson’s disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0–200 ms and 200–700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes.